Addressing key stages in the patient journey, from wellness to post–SARS-CoV-2 (COVID-19) infection recovery
Now, more than ever, laboratory testing is one crucial tool to help provide healthcare professionals (HCPs) reliable insights into a person’s health at a moment in time.

Armed with key insights from laboratory testing, Quest can help HCPs better understand a patient’s health, particularly at key points in the patient journey:

  • Baseline/routine care
  • Suspected respiratory or SARS-CoV-2 (COVID-19) infection
  • Post–SARS-CoV-2 (COVID-19) infection
Testing options to identify a care pathway forward

HCPs may consider a variety of testing approaches based on the needs of individual patients. Below are some of the tests HCPs may find helpful in developing a better understanding of their patients’ current health status.
Baseline/routine care

Routine testing, particularly if deferred during the pandemic, is an important tool for developing a baseline understanding of your patient’s health. These insights may be especially helpful if the patient were to develop a SARS-CoV-2 (COVID-19) infection in the future.
For patients with pre-existing thrombotic conditions:
For patients presenting with clinical symptoms consistent with a possible autoimmune disease:
Suspected respiratory or
SARS-CoV-2 (COVID-19) infection

In the case of common respiratory infections, a differential diagnosis is important to managing patient care, especially in the midst of the COVID-19 pandemic.
Post–SARS-CoV-2 (COVID-19) infection

Targeted testing that aligns to conditions that may manifest in patients recovering from a SARS-CoV-2 (COVID-19) infection can help identify potentially serious conditions and complications that require specialized care.
At nearly all levels of the US healthcare ecosystem, the COVID-19 pandemic is impacting the delivery of patient care. Patients continue to defer routine and chronic care at alarming rates.
49%
drop in primary care visits since the start of the pandemic, which may lead to serious downstream healthcare problems1
Lingering effects and serious complications for recovering patients

Increasingly, research shows many patients post–SARS-CoV-2 (COVID-19) infection are challenged by symptoms initially unrelated to the virus itself. HCPs must remain cognizant of the secondary effects and complications of the virus on a person's overall health. 

For some patients, significant health problems remain weeks and months after a SARS-CoV-2 (COVID-19) infection2,3—requiring additional care and monitoring by a physician:
Recent studies show that health complications post–COVID-19 illness may require additional ongoing monitoring and care for patients as they struggle to return to their baseline health pre-infection.4

As new insights and scientific research on SARS-CoV-2 (COVID-19) infections continue to unfold, this evidence can help improve our understanding of the illness itself, and may help us better understand what makes patients more susceptible to a poorer outcome from SARS-CoV-2 (COVID-19) infection.
Below are some of the areas where COVID-19 patients may need to be monitored for increased risk.
Post–COVID-19 conditions to consider monitoring for include autoimmune, respiratory/secondary infections, and tuberculosis.

As patients post–SARS-CoV-2 (COVID-19) infection report varying stages of fatigue and muscle weakness, detecting inflammation of the muscles and identifying cause can help inform appropriate treatment plans.

People who are ill with tuberculosis (TB) and other respiratory infectious diseases, such as SARS-CoV-2, influenza A/B, and RSV, often present with overlapping symptoms. 

Throughout the year, there are high influenza-like respiratory issues like allergies and asthma across the country, according to the CDC.5,6 Asthma patients might be at an increased risk from COVID-19.7 Quest continues to offer influenza, RSV, and allergy testing, including influenza A/B + RSV to differentially diagnose influenza A/B and RSV, as well as ImmunoCAP® to diagnose respiratory allergies.

While experience on SARS-CoV-2 (COVID-19) infection in tuberculosis (TB) patients remains limited, it is anticipated that people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if the TB treatment is interrupted.8 Quest offers convenient screening via TB blood testing, providing results after just 1 patient encounter.
HCPs may consider a variety of testing approaches based on the needs of individual patients. Below are some of the tests HCPs may find helpful in developing a better understanding of their patients’ current health status.

* This test could be considered where there is concern that the patient has developed COVID-19, has tested negative twice after being diagnosed with COVID-19 for purposes of determining recovery, or has relapsed or been re-infected. This test may be needed in these situations in order to determine an accurate diagnosis.
Cardiovascular risk assessment includes lipid values, inflammation, lipoprotein subfractions, and apolipoproteins. These tests may provide deeper insights into the residual risk of your patients. 

Viral infections may lead to an increase in risk for heart attacks. Uncovering heart attack risks that may be triggered by the COVID-19 virus is important to patient health. ADMA, Lp-PLA2, and MPO tests offer the ability to define current vascular inflammation of a given patient.

HCPs may consider a variety of testing approaches based on the needs of individual patients. Below are some of the tests HCPs may find helpful in developing a better understanding of their patients’ current health status.
There is a growing body of evidence of a high prevalence of blood clots, strokes, heart attacks, and organ failures among patients infected with SARS-CoV-2 (COVID-19).9 Consider monitoring platelet count, PT/aPTT, D-Dimer, and fibrogen, and continued monitoring of patients post-discharge is suggested for patients on extended prophylaxis.10 
HCPs may consider a variety of testing approaches based on the needs of individual patients. Below are some of the tests HCPs may find helpful in developing a better understanding of their patients’ current health status.
Post–SARS-CoV-2 (COVID-19) infection, neurological complications that may arise could include encephalitis, Myasthenia gravis (MG), and Guillain-Barré syndrome. 

Key, targeted panels aid in the diagnosis of paraneoplastic syndromes and autoimmune encephalopathies and related conditions. As symptoms commonly overlap across multiple conditions, identification of autoantibody specificity may allow syndromic classification and assist in diagnosis and management.

As patients may experience changes in muscular function and weakness post–SARS-CoV-2 (COVID-19) infection, appropriately identifying antibodies that are present in neuromuscular syndromes, such as MG and Guillain-Barré syndrome, may help inform an appropriate treatment path.
HCPs may consider a variety of testing approaches based on the needs of individual patients. Below are some of the tests HCPs may find helpful in developing a better understanding of their patients’ current health status.
Urine drug testing is used to identify specific drugs/metabolites present, and is also used as part of responsible drug monitoring when a definitive concentration of a drug is needed to guide management (eg, discontinuation of THC use according to treatment plan). Quest Diagnostics Patient Service Centers (PSCs) now offer urine drug testing so HCPs can provide the critical drug monitoring services patients need when in-office specimen collection is not an option. 
HCPs may consider a variety of testing approaches based on the needs of individual patients. We have numerous tests HCPs may find helpful in developing a better understanding of their patients’ current health status.
COVID-19 care test reference guide
New insights: Understanding the impact of COVID-19
SARS-CoV-2 (COVID-19) molecular (NAAT) testing access for presurgical patients 
SARS-CoV-2 (COVID-19) molecular (NAAT) testing access for immunocompromised patients
SARS-CoV-2 (COVID-19) antibody testing
Back to Patient Care brochure
SARS-CoV-2 positivity rate and Vitamin D levels
SARS-CoV-2 RNA (COVID-19) NAAT testing
SARS-CoV-2 (COVID-19) IgG antibody testing
COVID-19 news and updates
Back to Patient Care program
Peace of Mind program
Helping you manage deferred testing and care
Easy and convenient lab testing during COVID-19
Comparing SARS-CoV-2 (COVID-19) test options
The twindemic of COVID-19 and seasonal influenza
Influenza A/B and SARS-CoV-2 brochure
T-SPOT®.TB brochure
TBBloodTesting.com
Elevated cardiovascular risks associated with COVID-19 brochure
Respiratory viral infections and heart health
Inflammatory Markers for Defining Cardiovascular Risk
Coagulation abnormalities and COVID-19
COVID-19 and potential neurological complications
Neuroimmunology testing services
Post–COVID-19 infection and neurology complications
The epidemic within the pandemic: COVID-19 and drug monitoring services
Drug monitoring PSC/Peace of Mind brochure 
Clinical conversation: drug monitoring & patient care during the COVID-19 pandemic
Drug misuse during the COVID-19 pandemic
Medication adherence: challenges during COVID-19
* Required fields
Influenza A and B and SARS-CoV-2 panel test information

  • This test has not been FDA cleared or approved;
  • This test has been authorized by FDA under an EUA for use by authorized laboratories;
  • This test has been authorized only for the simultaneous qualitative detection and differentiation of nucleic acid from SARS-CoV-2, influenza A virus, and influenza B virus, and not for any other viruses or pathogens; and
  • This test is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner.

The antibody tests (sometimes known as the serology tests or IgG tests) are intended for use as an aid in identifying individuals with an adaptive immune response to SARS-CoV-2, indicating recent or prior infection. Results are for the detection of SARS-CoV-2 antibodies. IgG antibodies to SARS-CoV-2 are generally detectable in blood several days after initial infection, although the duration of time antibodies are present post-infection is not well characterized. At this time, it is unknown for how long antibodies persist following infection and if the presence of antibodies confers protective immunity. Individuals may have detectable virus present for several weeks following seroconversion. Negative results do not preclude acute SARS-CoV-2 infection. If acute infection is suspected, molecular testing for SARS-CoV-2 is necessary. The antibody test should not be used to diagnose acute SARS-CoV-2 infection. False positive results for the antibody test may occur due to cross-reactivity from pre-existing antibodies or other possible causes. 

  • The antibody tests and the molecular tests (together “All tests”) have not been FDA cleared or approved; 
  • All tests have been authorized by FDA under EUAs for use by authorized laboratories; 
  • The antibody tests have been authorized only for the detection of IgG antibodies against SARS-CoV-2, not for any other viruses or pathogens; 
  • The molecular tests have been authorized only for the detection of nucleic acid from SARS-CoV-2, not for any other viruses or pathogens; and, 
  • All tests are only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner


References:
  1. Mehrotra A, Chernew M, Linetsky D, Hatch H, Cutler D. What impact has COVID-19 had on outpatient visits?, To the Point (blog), The Commonwealth Fund. April 23, 2020. https://10.26099/ds9e-jm36 
  2. Yelin D, Wirtheim E, Vetter P, et al. Long-term consequences of COVID-19: research needs. Lancet Infect Dis. 2020;S1473-3099(20)30701-5 doi:10.1016/S1473-3099(20)30701-5
  3. Couzin-Frankel J. From ‘brain fog’ to heart damage, COVID-19’s lingering problems alarm scientists. Science. Printed July 31, 2020. Accessed September 4, 2020. doi:10.1126/science.abe1147
  4. Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network — United States, March–June 2020. MMWR Morb Mortal Wkly Rep. 2020;69(30):993-998. doi:10.15585/mmwr.mm6930e1
  5. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics. Asthma. Updated February 21, 2020. Accessed September 22, 2020. https://www.cdc.gov/nchs/fastats/asthma.htm 
  6. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics. Allergies and Hay Fever. Updated February 21, 2020. Accessed September 22, 2020. https://www.cdc.gov/nchs/fastats/ allergies.htm
  7. Centers for Disease Control and Prevention (CDC). Coronavirus Disease 2019 (COVID-19). People with certain medical conditions. Updated September 11, 2020. Accessed September 22, 2020. https://www. cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
  8. World Health Organization (WHO). Q&A: tuberculosis and COVID-19. Published May 11, 2020. Accessed September 22, 2020. https://www.who.int/news-room/q-a-detail/tuberculosis-and-the-covid-19- pandemic
  9. Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417-1418. doi:10.1016/S0140-6736(20)30937-5
  10. Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(23):2950-2973. doi:10.1016/j.jacc.2020.04.031
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